Nincs diac

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A PANCREAS BELGYÓGYÁSZATI BETEGSÉGEI Irodalomfigye
lo - 2005
Dr. Takács Tamás
Szegedi Tudományegyetem, I. sz. Belgyógyászati
Klinika Szeged, 2006
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ACUT PANCREATITIS
Diagnosztikus és terápiás algoritmus

US / CT amiláz

Pancreas necrosis/ folyadékgyülem
Pancreas ödéma

UH/CT-vezérelt vékonytu aspiráció,
bakteriális tenyésztés

epehólyag- és/vagy epeúti ko, tágult epeutak
(PCT)
Fertozött necrosis
Steril necrosis

lt72h
Konzervatív kezelés
ERCP, EST köextractio
Konzervatív kezelés (ET, antibiotikum?)
Sebészet

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ACUT PANCREATITIS
Diagnosztikus és terápiás algoritmus

etiológia
US / CT amiláz

Pancreas necrosis/ folyadékgyülem
Pancreas ödéma

UH/CT-vezérelt vékonytu aspiráció,
bakteriális tenyésztés

epehólyag- és/vagy epeúti ko, tágult epeutak
(PCT)
Fertozött necrosis
Steril necrosis

lt72h
Konzervatív kezelés
ERCP, EST köextractio
Konzervatív kezelés (ET, antibiotikum?)
Sebészet

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ACUT PANCREATITIS
Diagnosztikus és terápiás algoritmus

(PCT)
US / CT amiláz

Pancreas necrosis/ folyadékgyülem
Pancreas ödéma
diagnózis

UH/CT-vezérelt vékonytu aspiráció,
bakteriális tenyésztés

epehólyag- és/vagy epeúti ko, tágult epeutak
(PCT)
Fertozött necrosis
Steril necrosis

lt72h
Konzervatív kezelés
ERCP, EST köextractio
Konzervatív kezelés (ET, antibiotikum?)
Sebészet

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ACUT PANCREATITIS
Diagnosztikus és terápiás algoritmus

US / CT amiláz

Pancreas necrosis/ folyadékgyülem
Pancreas ödéma

UH/CT-vezérelt vékonytu aspiráció,
bakteriális tenyésztés

epehólyag- és/vagy epeúti ko, tágult epeutak
(PCT)
Fertozött necrosis
Steril necrosis

terápia
lt72h
Konzervatív kezelés
ERCP, EST köextractio
Konzervatív kezelés (ET, antibiotikum?)
Sebészet

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A randomized study of early nasogastric versus
nasojejunal feeding in severe acute
pancreatitis.Eatock FC, Chong P, Menezes N,
Murray L, McKay CJ, Carter CR, Imrie CW.Lister
Department of Surgery and Department of Nutrition
and Dietetics, Glasgow Royal Infirmary, Alexandra
Parade, Glasgow G31 2ER, Scotland.BACKGROUND
After 50 yr in which nasoenteric feeding was
considered contraindicated in acute pancreatitis
(AP), several clinical studies have shown that
early nasojejunal (NJ) feeding can be achieved in
most patients. A pilot study of early nasogastric
(NG) feeding in patients with objectively graded
severe AP proved that this approach was also
feasible. A randomized study comparing NG versus
NJ feeding has been performed. METHODS A total
of 50 consecutive patients with objectively
graded severe AP were randomized to receive
either NG or NJ feeding via a fine bore feeding
tube. The end points were markers of the acute
phase response APACHE II scores and C-reactive
protein (CRP) measurements, and pain patterns by
visual analogue score (VAS) and analgesic
requirements. Complications were monitored and
comparisons made of both total hospital and
intensive-care stays. RESULTS A total of 27
patients were randomized to NG feeding and 23 to
NJ. One of those in the NJ group had a false
diagnosis, thereby reducing the number to 22.
Demographics were similar between the groups and
no significant differences were found between the
groups in APACHE II score, CRP measurement, VAS,
or analgesic requirement. Clinical differences
between the two groups were not significant.
Overall mortality was 24.5 with five deaths in
the NG group and seven in the NJ group.
CONCLUSIONS The simpler, cheaper, and more
easily used NG feeding is as good as NJ feeding
in patients with objectively graded severe AP.
This appears to be a useful and practical
therapeutic approach to enteral feeding in the
early management of patients with severe AP. AM
J GASTROENTEROL 2005 100 432-439.
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Combination of early nasojejunal feeding with
modern synbiotic therapy in the treatment of
severe acute pancreatitis (prospective,
randomized, double-blind study)Article in
HungarianOlah A, Belagyi T, Issekutz A, Olgyai
G.Petz Aladar Megyei Oktato Korhaz, Gyor,
Sebeszeti Osztaly. olah.seb_at_arrabonet.huBACKGROU
ND We showed previously that probiotics
containing lactobacilli significantly improve the
outcome of acute pancreatitis. "Synbiotic 2000",
a new synbiotic composition with high colony
forming unit (CFU) comprises four different types
of pre- and probiotics. In this prospective,
randomized, double-blind study we evaluated the
role of "Synbiotic 2000" in the treatment of
severe acute pancreatitis. METHODS Patients with
severe acute pancreatitis were randomized into
two groups. Nasojejunal feeding was commenced
within 24 hours after admission in both groups
and continued for at least seven days. The first
group of patients received four different
lactobacilli preparations with 10(10) CFU,
respectively, and prebiotics containing four
bioactive fibres (inulin, beta-glucan, resistant
starch and pectin) in addition. Patients in the
second (control) group received only prebiotics.
RESULTS 62 patients with severe acute
pancreatitis completed the study. Altogether 8
patients died. We detected lower incidence of
multiorgan failure (MOF), septic complications
and mortality in the first group compared to the
control, but the differences were statistically
not significant. The total incidence of systemic
inflammatory response syndrome (SIRS) and MOF
were significantly different between the two
groups (8 vs. 14 p lt 0.05). Furthermore, the
number patients recovering with complications
were significantly less in the first group
receiving modern synbiotic therapy compared to
the control (p lt 0.05). Finally, we found lower
rate of late (over 48 hours) organ failure in the
first versus the control group (3.0 vs. 17.2).
CONCLUSION Our results suggest that early
nasojejunal feeding with synbiotic may prevent
organ dysfunctions in the late phase of severe
acute pancreatitis. In addition, our data also
indicate that the infection of pancreatic
necrosis may be associated with early phase organ
failure. MAGYAR SEB 200558 173-178
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Chronicus pancreatitis Diagnosztikus és terápiás
algoritmus
fájdalom fogyás steatorrhoea (diab. mellitus)
Klinikai tünetek
UH / CT
Norm. / nem meszes pancreas
Pancreas meszesedés (CCP)
Szurovizsgálatok (FE/L/ATT)
ERCP Lundh t. (S-MRCP)
neg. poz.
Belgyógyászati kez. - diéta/abstinencia -
fájdalom - szubsztitúció
Követés Egyéb vizsgálatok
Endoscopos kez. - cysta - köextractio - epeúti
stent
Sebészet -reszekció -dekompr. -marsupial.
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Chronicus pancreatitis Diagnosztikus és terápiás
algoritmus
etiológia
fájdalom fogyás steatorrhoea (diab. mellitus)
Klinikai tünetek
UH / CT
Norm. / nem meszes pancreas
Pancreas meszesedés (CCP)
Szurovizsgálatok (FE/L/ATT)
ERCP Lundh t. (S-MRCP)
neg. poz.
Belgyógyászati kez. - diéta/abstinencia -
fájdalom - szubsztitúció
Követés Egyéb vizsgálatok
Endoscopos kez. - cysta - köextractio - epeúti
stent
Sebészet -reszekció -dekompr. -marsupial.
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Cigarette smoking accelerates progression of
alcoholic chronic pancreatitisP. Maisonneuve,
A.B. Lowenfels, B. Mullhaupt, G. Cavallini, P.G.
Lankisch, J.R. Andersen, E.P. DiMagno, A.
Andren-Sandberg, L. Domellof, L. Frulloni, R.W.
AmmannGut 200554510-514  Background Smoking
is a recognised risk factor for pancreatic cancer
and has been associated with chronic pancreatitis
and also with type II diabetes. Aims The aim of
this study was to investigate the effect of
tobacco on the age of diagnosis of pancreatitis
and progression of disease, as measured by the
appearance of calcification and diabetes.
Patients We used data from a retrospective
cohort of 934 patients with chronic alcoholic
pancreatitis where information on smoking was
available, who were diagnosed and followed in
clinical centres in five countries. Methods We
compared age at diagnosis of pancreatitis in
smokers versus non-smokers, and used the Cox
proportional hazards model to evaluate the
effects of tobacco on the development of
calcification and diabetes, after adjustment for
age, sex, centre, and alcohol consumption.
Results The diagnosis of pancreatitis was made,
on average, 4.7 years earlier in smokers than in
non-smokers (p 0.001). Tobacco smoking
increased significantly the risk of pancreatic
calcifications (hazard ratio (HR) 4.9 (95
confidence interval (CI) 2.310.5) for smokers v
non-smokers) and to a lesser extent the risk of
diabetes (HR 2.3 (95 CI 1.24.2)) during the
course of pancreatitis. Conclusions In this
study, tobacco smoking was associated with
earlier diagnosis of chronic alcoholic
pancreatitis and with the appearance of
calcifications and diabetes, independent of
alcohol consumption.
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Chronicus pancreatitis Diagnosztikus és terápiás
algoritmus
fájdalom fogyás steatorrhoea (diab. mellitus)
Klinikai tünetek
diagnózis
UH / CT
Norm. / nem meszes pancreas
Pancreas meszesedés (CCP)
Szurovizsgálatok (FE/L/ATT)
ERCP Lundh t. (S-MRCP)
neg. poz.
Belgyógyászati kez. - diéta/abstinencia -
fájdalom - szubsztitúció
Követés Egyéb vizsgálatok
Endoscopos kez. - cysta - köextractio - epeúti
stent
Sebészet -reszekció -dekompr. -marsupial.
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Chronicus pancreatitis Diagnosztikus és terápiás
algoritmus
fájdalom fogyás steatorrhoea (diab. mellitus)
Klinikai tünetek
UH / CT
Norm. / nem meszes pancreas
Pancreas meszesedés (CCP)
Szurovizsgálatok (FE/L/ATT)
ERCP Lundh t. (S-MRCP)
neg. poz.
Belgyógyászati kez. - diéta/abstinencia -
fájdalom - szubsztitúció
Követés Egyéb vizsgálatok
Endoscopos kez. - cysta - köextractio - epeúti
stent
Sebészet -reszekció -dekompr. -marsupial.
terápia
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EUROPEAN PANCREATIC CLUBSZEGED - 2009